As Omicron spreads through the UK, staff absences and full hospital beds are putting immense pressure on the NHS.
Yet NHS insiders who have spoken to the New Statesman suggest it is already overwhelmed, even if this doesn’t manifest in the footage of packed intensive care units we saw on our screens during the first and second waves – or the clips of patients being turned away from hospitals in Italy in March 2020.
At least eight hospital trusts have declared critical incidents amid staff Covid absences this year, some heart attack and stroke patients are being advised by ambulance call handlers get a lift to hospital, and 17 hospitals in Greater Manchester are postponing planned surgery and appointments as local case levels rise.
Trying to play catch-up on the six million-long waiting list for hospital procedures as well as treating Covid-19 patients could be more difficult than the spikes of coronavirus hospitalisations we’ve seen in the past 22 months.
To understand what the crisis means day-to-day, the New Statesman is speaking to figures on the front line about their experiences.
First is Helen, a paramedic and emergency care assistant working in the south of England. She is using a pseudonym and wishes not to name her ambulance service so that she can speak openly.
Ambulances are taking longer to reach patients in the UK. The most recent figures for England show that the average response time for “category one” cases – life-threatening illnesses or injuries, like a heart attack or inability to breathe – was nine minutes and ten seconds, missing the NHS standard of eight minutes.
Category two call-outs, for emergencies like strokes or chest pain, took an average of 46 minutes and 37 seconds: well below the 18-minute NHS standard.
Between September and October last year, the average response time for an ambulance rose by 25 per cent – from 1 hour and 17 minutes to 1 hour and 36 minutes – according to analysis by the medical negligence team at Bond Turner, a law firm.
Covid-19 is just part of this problem.
People are calling 999 more often, in part because of the pent-up demand for healthcare following the lockdowns. There are a record number of patients on the NHS waiting list, which has built up since the pandemic hit.
Stretched primary care and social care services are also at play: some patients are turning to A&E over their GP, for example, and hospital beds are taken up by those who could be discharged to care homes or domestic care packages – but the provision simply isn’t there.
Helen waits for hours with patients in the back of her ambulance in queues outside hospital because beds are not immediately available for them.
“Upon arrival, the patient enters the RAT [rapid assessment and triage] area, where they are assessed, blood tests undertaken and scans booked, all as required,” she says.
Once that’s done, however, she will often have to take her patient back into the ambulance to wait. She monitors the patient herself – observing blood pressure, heart rate and rhythm, temperature, blood sugar and oxygen levels, as well as doing continual neurological tests.
She has some medications on board the ambulance, and is also able to put her patient on a drip for intravenous antibiotics if they’ve been prescribed, for example.
In the meantime, there is little else she can do but wait.
Other paramedics have described their role to me as “glorified nurses” in this period.
All the hours they are queueing, they are unable to attend other emergencies. “While we’re with our patient outside hospital, we can hear our radios going off,” Helen says. These calls are from control staff asking if there is a crew free to respond to life-threatening calls, “as they have no resources to send”.
Recently, Helen spent an entire 12-hour shift, and then nearly three hours of overtime, with just one patient in the ambulance. When she finally finished work, she handed her patient over to another ambulance crew in the hospital car park – there was still no bed available.
“It can be extremely stressful for both the ambulance crew and the patient – especially if the patient is clinically unstable, or deteriorates while on board the ambulance,” she says.
“Often, we have extremely unwell patients to care for, and it is a worry when driving to the hospital now because you don’t know how long the wait will be before we can enter the hospital with them.”
Elderly patients who have fallen over and broken their hips “can and often do wait for hours for an ambulance to arrive… only to arrive at hospital and have to wait several more hours just to enter the hospital.”
Ambulance stretchers can be very uncomfortable for patients, as they are “not designed for lying on for long periods of time”. Paramedics have taken to cushioning them with blankets.
Blue-light patients who need immediate resuscitation can end up waiting an hour before getting into hospital, the New Statesman revealed in November, when another paramedic disclosed that people were dying as a result.
“You should go straight into resus [the resuscitation room in A&E], but the average I would say is half an hour now, and 45 minutes, an hour, isn’t unheard of,” said a paramedic from a different hospital trust. “We just have to keep managing the patient in the back, and hope for the best they don’t deteriorate and don’t die.”
During Covid-19 waves, this situation takes on an extra danger for the crew, particularly now in cold weather when ambulance doors cannot be left open.
“I fear for my own safety as well as those of my colleagues, as we have had to wait with Covid-positive patients in an ambulance for several hours before we can go into the hospital,” Helen reveals. “The viral load we are exposed to in those instances must be enormous.”
The recommended protective equipment – an apron, gloves, goggles and a standard surgical mask – don’t “feel sufficient” to Helen and her colleagues when they’re with a Covid or suspected Covid patient in a “confined space for a prolonged period of time”.
This also risks further staff absences, from contracting the virus and having to self-isolate. NHS staff absences due to Covid-19 more than doubled in the weeks leading up to Christmas, as Omicron spread rapidly.
“I hope that something will change in future,” says Helen. “This just isn’t sustainable.”
Do you want to tell us about your experience on the NHS, primary care or social care front line? Get in touch: firstname.lastname@example.org.